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What are Options for Replacing Missing Teeth?

Tobias K. Boehm (July 4, 2025)

Tooth loss is common, and at least 1/3 of adults in California have lost one or more teeth before age 65 (1). Tooth loss usually happens because of cavities (caries), gum disease (periodontal disease) and accidents. Sometimes, dentists may recommend removing some teeth because the teeth prevent successful treatment or teeth that are beyond repair.

Here are the options for replacing missing teeth, along with requirements, benefits, disadvantages and typical uses:

  1. Do nothing
    • Requirements: None. Not replacing a tooth is always an option.
    • Benefits: Since there is no treatment, this is the least invasive, least costly and least time consuming choice in the short term.
    • Disadvantages: Typically, there are many disadvantages of missing teeth. Missing teeth usually result in reduced chewing ability. Tooth loss results in poor nutrition and has been linked to higher dementia risk (2). Missing teeth can be unsightly. Surrounding teeth may move into the spot of the missing tooth over time, causing more reduced chewing ability and teeth that look out of place. With time, the jaw bone that used to hold in the missing tooth will shrink, resulting in unsightly gum contours. Without tooth support, cheeks and lips may appear sunken in, adding to an aged appearance. It may be harder to replace the missing tooth over time as jaw bone and gum tissue shrink in the area of the missing tooth.
    • Typical use: Dentists usually do not replace 3rd molars and may not recommend replacing 2nd molars.
  2. Implant(s)
    • (Creative Commons License, from Alexmit Art, Wikimedia)
    • Requirements: Replacing missing teeth with dental implant-supported crowns, bridges or dentures usually requires enough bone and gum tissue to be present. If there is not enough bone or gum tissue, surgeons typically recommend bone or gum grafting procedures to help rebuild the missing tissues. Dentists usually need to order imaging studies at additional cost before implant treatment to determine how implants need to be placed. Implants should be done last after all other dental treatment is finished, and implant therapy should be avoided in young individuals who are still growing.
    • Benefits: Implants  can provide the most tooth-like replacement. Implants can provide fixed tooth replacement that restores chewing ability.
    • Disadvantages: Implant therapy is often the most costly treatment for replacing missing teeth. Implant therapy may also be the slowest treatment as there may be months-long wait times for healing. Implants can fail just like any other dental treatment, and implants can develop gum disease that is difficult to treat. Implant surgery carries a number of significant risks, and it may be difficult to recreate the exact appearance of the original missing tooth. Implants need regular profesional maintenance, which carries additional cost.
    • Typical use: Dentists will usually recommend this as the best choice for replacing most teeth, unless there are good reasons against implant therapy.
  3. Bridge (Fixed partial denture)
    • Bridge to replace missing teeth made of ceramic (Creative Commons License, from Wagonerj, Wikimedia)
    • Requirements: A bridge needs to be supported by surrounding teeth that are healthy and can take up additional chewing forces. Bridges are difficult if more than one tooth is missing in each space. Typically, bridges are impossible if there is not a tooth on either side of the missing tooth space.
    • Benefits: Bridge  therapy provides fixed tooth replacement and is typically much quicker than implant therapy. It may also be cheaper than implant therapy. Sometimes, bridge therapy may provide the most esthetic solution for tooth replacement. Bridge therapy usually does not require oral surgery. If an adhesive bridge is used, this may be the least invasive fixed tooth replacement and may presser as ve the teeth as they are. Adhesive bridge therapy can be a great option for younger patients who cannot receive implants because of their age.
    • Disadvantages: Bridge therapy may require cutting down perfectly healthy teeth to attach the bridge. Bone loss and gum tissue loss continue under a bridge in the area of the missing tooth. It usually is more difficult to keep a bridge clean as flossing is not possible. Food may get stuck under neath a bridge. With time, bridges likely have to be replaced because of wear and tear. If a bridge fails, it often results in loss of the teeth that supported the bridge.
    • Typical use: Bridges usually are the solution for missing teeth if surgery is not an option or if there is not enough tissue support for an implant. An adhesive bridge may be a good temporary solution until implant therapy is possible, especially for younger individuals who cannot receive implants.
  4. Denture
    • removable partial denture on a stone model (Creative Commons license, from niks98, Wikimedia)
    • Requirements: Almost none. It helps if there is sufficient ridge height to hold dentures in place. If there are bony growths in the jaws (exostoses, tori), surgery is needed to remove them. Surgery may also be needed to make ridges more even or extend the floor of the mouth.
    • Benefits: Dentures are often the least expensive tooth replacement, quick to fabricate and least invasive. Dentures can be done for almost any patient lacking teeth. Dentures can provide the most esthetic solution as they give dentists complete control over tooth shape, tooth color, tooth position, gum color and gum shape. Dentures are easy to clean and present the least burden to caregivers for individuals who cannot perform their own oral hygiene.
    • Disadvantages: Dentures are the least tooth-like replacement as they are removable, move inside the mouth, are large and bulky. Chewing and eating must be relearned with dentures. Speech is different with dentures and it takes time getting used to wearing dentures. Dentures only provide a fraction of the chewing ability. Bone and gum tissue continue to shrink, requiring relines and rebases of the denture on a regular basis. Dentures usually last about 10 years before they need to be replaced (3).
    • Typical use: Denture therapy is usually done when bridge or implant therapy is not feasible.

References

(1) Gadgil M, Jackson R, Rosenblatt N,  Aleemuddin A, Peck C, Bates J. Status of Oral Health in California: Oral Disease Burden and Prevention. April 2017. California Department of Public Health. https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CDCB/CDPH%20Document%20Library/Oral%20Health%20Program/Status%20of%20Oral%20Health%20in%20California_FINAL_04.20.2017_ADA.pdf

(2) Fang WL, Jiang MJ, Gu BB, Wei YM, Fan SN, Liao W, Zheng YQ, Liao SW, Xiong Y, Li Y, Xiao SH, Liu J. Tooth loss as a risk factor for dementia: systematic review and meta-analysis of 21 observational studies. BMC Psychiatry. 2018 Oct 20;18(1):345. doi: 10.1186/s12888-018-1927-0. PMID: 30342524; PMCID: PMC6195976.

(3) Taylor M, Masood M, Mnatzaganian G. Longevity of complete dentures: A systematic review and meta-analysis. J Prosthet Dent. 2021 Apr;125(4):611-619. doi: 10.1016/j.prosdent.2020.02.019. Epub 2020 Apr 28. PMID: 32359852..

About the author:

Tobias K. Boehm, DDS, PhD, MBA, PC, DABP, DICOI, FGDIA is the founder of The Dental Institute, executive director at The Defeating Epilepsy Foundation and a professor at Western University of Health Sciences where he teaches and practices a periodontal specialist.